Healthcare Provider Details

I. General information

NPI: 1740268622
Provider Name (Legal Business Name): VICTOR ALEXIS PINKES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 ATWOOD AVE
CRANSTON RI
02920
US

IV. Provider business mailing address

135 LAUREL WOOD
EAST GREENWICH RI
02818-1574
US

V. Phone/Fax

Practice location:
  • Phone: 401-493-4540
  • Fax: 401-944-7727
Mailing address:
  • Phone: 401-398-1762
  • Fax: 401-767-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number153982
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number10635
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number153982
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: